Red Book Online Outbreaks: Salmonella Outbreak Linked to Cucumbers

As of January 8, 2025, this outbreak is over.

Overview

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to investigate a multistate outbreak of Salmonella Typhimurium infections. Epidemiologic and traceback data show that cucumbers grown by Agrotato, S.A. de C.V. in Sonora, Mexico, including recalled cucumbers from SunFed Produce, LLC. may be contaminated with Salmonella and may be making people sick.

As of January 8, 2025, a total of 113 people infected with the outbreak strain of Salmonella have been reported from 23 states. Illnesses started on dates ranging from October 12, 2024, to December 7, 2024. Of the 99 people for whom information is available, 28 have been hospitalized. No deaths have been reported.

Many companies have recalled whole fresh cucumbers grown by Agrotato, S.A. de C.V. in Sonora, Mexico. In addition, companies have recalled sliced cucumbers or foods made with cucumbers like wraps and salads in some states. Refer to CDC’s food recall table. FDA continues to work with additional importers that received cucumbers grown by Agrotato S.A. de C.V.

Clinical Guidance

Presentation

• Most people infected with Salmonella experience diarrhea, fever, and stomach cramps. Symptoms typically start 6 hours to 6 days after swallowing the bacteria.  Most people recover without treatment after 4 to 7 days.

 Who is at the highest risk/complications?

• The incidence of Salmonella infection is highest in children younger than 4 years of age. In the United States, rates of invasive infections and mortality are higher in infants, elderly people, and people with hemoglobinopathies (including sickle cell disease) and immunocompromising conditions (eg, malignant neoplasms, HIV infection).

Diagnosis

• L monocytogenescan be recovered readily on blood agar from cultures of blood, cerebrospinal fluid (CSF), meconium, placental or fetal tissue specimens, amniotic fluid, and other infected tissue specimens, including joint, pleural, or peritoneal fluid. 
• Polymerase chain reaction (PCR) assays can be used to detect L monocytogenesin blood and CSF. 
• Stool cultures are generally not useful for the diagnosis of Listeria

Patients should be seen by their pediatrician if they present with the following symptoms of Salmonella infection:

• Diarrhea and a fever higher than 102°F
• Diarrhea for more than 3 days that is not improving
• Bloody diarrhea
• Not tolerating oral liquids
• Signs of dehydration, such as:
  • Decreased urine output
  • Dry mucous membranes
  • Orthostatic hypotension

Diagnosis

• Isolation of Salmonella organisms from cultures of stool, blood, urine, bile (including duodenal fluid containing bile), and material from foci of infection is diagnostic. Salmonella gastroenteritis is diagnosed by stool culture or molecular testing (including PCR); stool testing should be obtained in all children with bloody diarrhea or unexplained persistent or severe diarrhea. See Red Book Salmonella diagnostic tests.

Risk Mitigation

• CDC advises people should not eat any recalled cucumbers; they should be thrown away or returned to the store where they were purchased.  People should wash items and surfaces that may have touched the recalled cucumbers using hot soapy water or a dishwasher.

Treatment

• Antimicrobial therapy usually is not indicated for patients with either asymptomatic infection or uncomplicated gastroenteritis caused by Salmonella, because therapy does not shorten the duration of diarrheal disease, can prolong duration of fecal shedding, and increases symptomatic relapse rate. Antimicrobial therapy is recommended for gastroenteritis caused by Salmonella in people at increased risk for invasive disease, including infants younger than 3 months and people with chronic gastrointestinal tract disease, malignant neoplasms, hemoglobinopathies, HIV infection, or other immunosuppressive illnesses or therapies. Antibiotics should also be considered for those experiencing severe symptoms such as severe diarrhea or prolonged or high fever. If antimicrobial therapy is initiated in patients in the United States with presumed or proven Salmonella gastroenteritis, a blood and a stool culture should be obtained prior to antibiotic administration. Most cases of Salmonella gastroenteritis are treated empirically. If the person appears ill or has evidence of disseminated infection, hospitalization along with initiation of a broad-spectrum parenteral cephalosporin often is prescribed. Oral antimicrobials, such as azithromycin may be considered for patients who do not appear ill or have evidence of disseminated infection. If cultures are obtained, definitive therapy should be based on the susceptibility of the organism isolated.

Reporting

• Suspected cases should be reported to the local department of public health.

Resources

• For more information see the Red Book chapter on Salmonella Infections